Suturing and dividing organic tubular structures

ABSTRACT

A cartridge and an instrument which, together serve to mechanically suture and divide organic tubular structures, such as blood vessels. The cartridge houses a plurality of staples and operates in three stages. After the tubular structure is inserted between the jaws of the cartridge, the cartridge jaws close, a pair of pushers come forward and suture the organic structure in two spaced locations with a pair of surgical staples, and a blade comes forward and divides the tubular structure at a position intermediate the two staples. The staples are indexed and readied for discharge by means of a pair of leaf springs which act between a fixed rail assembly and a movable wrap assembly. The instrument is adapted to coact with the novel cartridge and depends upon the interaction of three springs to bring about the three-stage operation of the cartridge.

[451 May as, 1972 SUTURING AND DKVHDING ORGANIC TUBUlL STRUCES 3,006,34410/1961 Vogelfanger ..l28/318 Primary ExaminerRichard A. Gaudet [72]Inventors: Douglas G. Noiles, New Canaan; Graham Assistant Examiner j BMitchel] Bryan Rldgefield both of Attorney-Fleit, Gipple & Jacobson [73]Assignee: United States Surgical Corporation, Baltimore, Md. [57]ABSTRACT [22] Filed: Oct. 13, 1970 A cartridge and an instrument which,together serve to mechanically suture and divide organic tubularstructures, [2}] Appl' 80451 such as blood vessels. The cartridge housesa plurality of staples and operates in three stages. After the tubularstructure is [52] U.S. Cl ..128/305, 128/326, 29/243.57 inserted betweenthe jaws of the cartridge, the cartridge jaws A611) 12 close, a pair ofpushers come forward and suture the organic Field of Search -123/3O5,313, 319, 326, 334 R, structure in two spaced locations with a pair ofsurgical sta- 211 212 ples, and a blade comes forward and divides thetubular struc- R9 227/19 ture at a position intermediate the twostaples. The staples are indexed and readied for discharge by means of apair of leaf [56] References cued springs which act between a fixed railassembly and a movable UNXTED STATES PATENTS wrap assembly. Theinstrument is adapted to coact with the novel cartridge and depends uponthe interaction of three Potekhina et a1 prings to bring about thethree-stage operation of the car- 3,589,589 6/1971 ....227 153 tridge,3,584,628 6/1971 ...128/305 3,545,444 12/1970 128/305 19 Claims, 12Drawing Figures I22 28 #0 /44 26 loo I08 1/30 "Tl-'1 //2 /42 in I Ha ai-L //W /Ai Patented May 30, 1972 4 SheetsSheet l INVENTORS Douglas G.No/les,

Graham W Bryan ATTORNEYS Patented May 30, 1972 4 Sheets-Sheet zATTORNEYS llll Doug/as G/Voi/es Graham W- Bryan Patented May 30, 1972 4Sheets-Sheet 5 s 0 RS WNE W S mm 0 Wm 06 Patented May 30, 1972 4Sheets-She t 4 INVENTORS Douglas 6 Noi/es lg Graham W Bryan M 4 MWATTORNEYS NM QFK SUTURING AND DIVIDING ORGANIC TUBULAR STRUCTURESBACKGROUND OF THE INVENTION In copending application Ser. No. 64,749entitled METHOD AND CARTRIDGE FOR LIGATING ORGANIC TUBULAR STRUCTURES,and assigned to the present assignee, a novel method-and cartridge forligating, suturing and dividing organic tubular structures by means ofsurgical staples are disclosed. This copending patent application isdirected, in part, to a cartridge which accepts an organic tubularstructure and which mechanically encloses the tubular structure betweenits jaws, advances a pair of U-shaped staples toward the tubularstructure by means of a pusher element and then surrounds the structureby the staples and crimps the staples in such a manner that the organictubular structure is sealed at two spaced locations. Once the tubularstructure is so sealed, a thumb'operated knife blade is moved forward todivide the structure intermediate the staples.

In the copending US. patent application noted in the precedingparagraph, a useful cartridge is disclosed. This cartridge, however, isthe result of initial thoughts directed to a new concept. Accordingly,there are many areas where refinements of the initial concept can bemade. For example, in that cartridge, only two staples can be housed,fed and crimped about the organic tubular structure. Since, in practicalcircumstances, a number of suturing and dividing operations must bemade, it would be best if a plurality of staple pairs could be housed inthe cartridge. Further, the dividing operation performed by thecartridge noted above is done by means of a thumb-operated knife blade.Therefore, with this cartridge, the surgeon is required to perform thesuturing and dividing operations in two independent stages. Again, whilesuch a configuration is workable, it is not the best possibleconfiguration.

It is toward the refinement of the cartridge disclosed in the copendingUS. patent application noted above, and the elimination of the drawbacksassociated therewith, that the present invention is directed.

SUMMARY OF THE INVENTION The present invention relates to a cartridgeand an instrument which, together are capable of mechanically andrepetitiously ligating, suturing and dividing organic tubularstructures, such as blood vessels and the like. The inventive cartridgehouses a plurality of staple pairs, on the order of fifteen, and derivesits power from the associated instrument.

The cartridge operates in three stages. Once the tubular structure isinserted within the area of its jaws, the cartridge wrap, or main bodyof the cartridge, is moved forward and toward an anvil assembly fixed onthe instrument, thereby enclosing the tubular structure within the jawsof the cartridge. Then, a pair of pusher elements are advanced alongtheir respective fixed rail assemblies and urge a pair of staples towardrespective anvil assemblies. At the forward portions of the pusherstrokes, the respective staples encircle the tubular structure at spacedlocations and crimp about the structure in such a manner that thetubular structure is sealed at two locations. Finally, and with thepushers at the forwardmost portions of their strokes, a knife bladeadvances and divides the tubular structure intermediate the two staples.This threestage operation is performed by a surgeon by simply squeezingthe handle of the associated instrument.

The instrument, to operate the three-stage cartridge, is also ofthree-stage design. The forward end of the instrument is provided withthree saddles which associate, respectively, with the cartridge wrap,the pusher and the knife. The forward end of the instrument is alsoprovided with means for fixedly securing the rail assemblies of thecartridge to the instrument.

Three spring elements are housed in the instrument and, in conjunctionwith a cam and trigger element, operate the cartridge wrap, the pushersand three knife through three saddle elements. The instrument has afixed handle and a handle pivotally mounted with respect to the fixedhandle. When the instrument handles are squeezed together, the movablehandle pivots with respect to and moves toward the fixed handle. With acartridge mounted on the instrument, the initial squeezing of the handlemoves the cartridge wrap toward the fixed anvil assemblies, and thefurther squeezing advances the pushers toward the respective anvils andultimately urges the knife toward the front of the instrument to effecta cutting operation.

Because of the three-stage operation, depending upon the interaction ofthree springs, the forces which need to be exerted on the handle varywith the handle depression. Further causing variance in the requiredoperating forces are the distinct operations of the cartridge. Toeliminate the distinct feel" in the hand of the surgeon thatdifferential forces are required of him, the inventive instrument isprovided with a variable cam element operating between the power shaftsof the instrument and the handle thereof. The cam surface is contouredin such a manner that the force required to operate the handle isrelatively constant notwithstanding variations in the required forceinputs to the cartridge. In this manner, the surgeon is unaware thatthree distinct stages of operation occur each time he activates theinstrument.

The cartridge houses a plurality of staple pairs. When the cartridge isoperated by the instrument, the staple pairs are indexed in a simple,effective and unique manner. When the cartridge is shipped, theforwardmost two staples are housed in the respective planes of thepushers, ready for ejection. The remaining pairs of staples are housedin the respective planes of a pair of guiding tracks. The staples aremaintained in their respective tracks by having their arms biasedagainst the track walls.

The staples in the guiding tracks are held fixed in the cartridge wrapduring the first ligating, suturing and dividing operation. Only theforwardmost two staples are affected by the first operation, beingejected by the pushers. When, however, the cartridge wrap retracts fromthe anvil assemblies, after the first operation of the cartridge, a leafspring assembly integral with each rail assembly, in turn integral witheach anvil assembly, maintains the staples fixed with respect to therail assemblies, thereby, in relative terms, advancing the staples inthe cartridge wrap. During the retraction of the cartridge wrap, theforwardmost two staples are shifted from the respective planes of theguiding tracks to the respective planes of the pushers. When thecartridge wrap returns to its rearwardmost position, the cartridge isready for another firing operation.

As noted previously, all but the forwardmost two staples are held fixedin the cartridge wrap during the movement of the wrap toward the anvilassemblies. When the cartridge wrap moves forward, the staples are heldfixed in the wrap by means of a second leaf spring assembly integralwith each side of the cartridge wrap.

The novel cartridge, as noted previously, is shipped with a pair ofstaples ready for ejection. To ensure that the respective pushers aremaintained in proper alignment for insertion on a powering instrument,and to prevent the respective pushers from accidentally ejecting theirassociated staples, the pushers are rigidly secured together and areheld fixed with respect to the cartridge wrap until acted upon by theinstrument. Similarly, during shipment, the knife is held fixed withrespect to the wrap.

A further feature guilt into the inventive cartridge is an ejectormechanism by which mechanism the organic tubular structure, after havingbeen sutured and divided, is forced out of the jaws of the cartridge. Tothis end, an ejector plate positioned intermediate the respective anvilassemblies, is made to move into the area of the anvil, to contact bothsegments of the divided tubular structure, and to urge the segments outof engagement with the respective anvil assemblies. In this manner, thesurgeon need not make a conscious effort to ensure that the ligated anddivided tubular structures are out of the jaws of the cartridge beforeretracting the cartridge from the operating arena.

Further to the above, the inventive cartridge is provided withtransparent windows either on the sides thereof or on the top thereof,these windows being in the planes of the staples. In this manner, thesurgeon can easily inspect the cartridge to ascertain the number ofstaple pairs remaining therein. The chance of a wasted stroke is therebygreatly diminished.

Accordingly, it is one object of the present invention to provide acartridge for housing a plurality of staple pairs and adapted tomechanically ligate, suture and divide organic tubular structures withthe aid of surgical staples.

A further object of the present invention is to provide a novelcartridge capable of ligating, suturing and dividing organic tubularstructures and equipped with means for simply and reliably indexing aplurality of staple pairs.

Yet a further object of the present invention is to provide a novelcartridge for ligating, suturing and dividing organic tubular structuresand equipped with simple leaf spring assemblies for advancing thestaples in the cartridge.

A further object of the present invention is to provide a novelcartridge for ligating, suturing and dividing organic tubular structuresand equipped with means to ensure that the cartridge may be shipped withmisalignment of its elements or accidental discharge of its staples.

Still a further object of the present invention is to provide arelatively inexpensive and disposable cartridge for ligating, suturingand dividing organic tubular structures.

A further object of the present invention is to provide a novelcartridge for ligating, suturing and dividing tubular organicstructures, the cartridge housing a plurality of staple pairs and beingprovided with means for easily recognizing the number of staple pairsremaining in the cartridge.

Yet another object of the present invention is to provide a three-stageinstrument adapted to associate with a cartridge and to function,together with the cartridge, to ligate, suture and divide tubularorganic structures.

Yet a further object of the present invention is to provide a simplehand operated instrument adapted for three-stage operation with the aidof three independent spring assemblies.

Still a further object of the present invention is to provide a novelinstrument adapted to associate with a staple-housing cartridge, theinstrument and cartridge together serving to ligate, suture and divideorganic tubular structures, and the instrument being provided with cammeans whereby the mechanical advantage associated with the instrumenthandle varies inversely with the forces necessary to bring about thecartridge operation.

These and other objects of the present invention, as well as many of theattendant advantages thereof, will become more readily apparent whenreference is made to the following description taken in conjunction withthe accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side view, partially insection, of the surgical instrument forming a part of the presentinvention with its associated cartridge indicated in phantom;

FIG. 2 is a side view of the forward region of the inventive surgicalinstrument showing portions of the instrument when its trigger is inposition 2 of FIG. 1;

FIG. 3 is a side view of the forward region of the inventive surgicalinstrument showing portions of the instrument when its trigger is inposition 3 of FIG. 1;

FIG. 4 is a side view of the forward region of the inventive surgicalinstrument showing portions of the instrument when its trigger is inposition 4 ofFIG. 1;

FIG. 5 is a top view of the staple-carrying cartridge forming a part ofthe present invention;

FIG. 6 is a side view of the cartridge illustrated in FIG. 5;

FIG. 7 is a cross-section of the inventive cartridge taken along line7-7 ofFIG. 5;

FIG. 8 is a cross-section of the inventive cartridge taken along line 88of FIG. 5;

FIG. 9 is a front view of the inventive cartridge;

FIG. 10 is a cross-section of the inventive cartridge taken along line10-10 of FIG. 5;

FIG. 11 is a cross-section of the inventive cartridge taken along linel111 ofFIG. 10; and

FIG. 12 is a side view of the ratchet assemblies when in the respectivepositions shown in FIG. 1 1.

DETAILED DESCRIPTION OF THE DRAWINGS Before beginning an explanation ofthe inventive surgical instrument, and to enhance the understanding ofthe operation of the same, there follows a brief description of theoperation of the inventive staple-carrying cartridge. As notedpreviously, the cartridge serves to successively ligate, suture anddivide organic tubular structures. The main cartridge includes a mainbody portion slidable on a pair of fixed rail and anvil assemblies, apair of pusher elements, and a knife blade. In carrying out itsthree-stage operation after the organic tubular structure is in positionbetween the main body portion and the fixed anvil assemblies, the mainbody portion is moved forward until it abuts the fixed anvil assembliesand completely encircles the tubular structure within the jaws of thecartridge. Then, the pushers are activated, thereby ejecting a pair ofstaples from the main body and forming the staples about the organictubular structure. After the staples are formed, the knife blade movesforward and divides the tubular structure at a position intermediate thestaple locations.

During the cartridge operation described in the preceding paragraph,three distinct forces are required. First, the main body portion of thecartridge must be moved forward with respect to the fixed rail and anvilassemblies. Second, after the main body portion is in abuttment with theanvil assemblies, the pushers must be driven forward to eject and form apair of staples. And, third, once the staples are formed and the pushersare in their forwardmost positions of travel, the knife blade must beadvanced.

With this background, the requirements of operation of the inventiveinstrument should be clear and the manner in which these requirementsare met will be clear from the following, The inventive instrument isshown generally at 10 and has mounted thereon a cartridge 12. Theinstrument is defined by a main body portion 14 having a fixed handle16, a handle 18 mounted for pivotable movement about a pin 20, a barrel22 and a nose 24. Three saddle members 26, 28 and 30, respectively,extend from the nose 24 of the instrument 10 and are adapted toassociate, respectively, with the cartridge knife, the cartridgepushers, and the cartridge main body. The forwardmost saddle 26 isintegral with a solid tube 32 extending from the saddle 26 to the rearportion of the barrel 22. On the end of the tube 32 is a cap 34, thefunction of which will become clear from the following. The saddle 28 isintegral with a hollow rod 36 which extends from the saddle 28 towardthe rear portion of the barrel 22, terminating in a ring-like flange 38.The saddle 30 takes the form of a spool surrounding the hollow rod 36and is free to slide therealong.

To bring about the three-stage operation of the instrument 10, inresponse to the required three-stage operation of the staple-carryingcartridge 12, the three saddles 26, 28 and 30 are controled by theoperation of the cartridge 12 and the interaction of three springs. Afirst spring 40 surrounds the hollow rod 36 and is maintained incompression between the ringlike flange 38 integral with the tube 36 andan inner wall 42 of nose 24. Spring 40 thereby biases the saddle 28toward the nose 24 of the instrument 10. A second spring 44, incompression, surrounds the hollow tube 36, and acts between the rearwall of the saddle 30 and a front wall 46 of the nose portion 24. Spring44 thereby serves to bias the saddle 30 away from the nose 24. The thirdspring 48 is located in the rear portion of the barrel 22 and acts incompression between the cap 34 integral with the rod 32 and thering-like flange 38 integral with the rod 36 thus biasing the saddles 26and 28 toward one another. Preferably, springs 40 and 44 are coilsprings, whereas springs 48 take the form of Belvill washers, or discsprings. In view of their desired functions, the spring forces must berelated as follows. Spring 44 exerts the least spring force, in thepresent example on the order of 4 pounds. Spring exerts an intennediateamount of force, in the specific example on the order of 8 pounds. And,spring 48 is adapted to exert a force of on the order of 60 pounds.

As noted previously, the operation of the staple-carrying cartridge, andthus of the inventive instrument, is carried out in three-stages. And,due to the varying functions of the cartridge elements, distinct andvarying forces are required to bring about each function. That is, whilerelatively little force is required to move the main body of thecartridge toward the fixed anvil assemblies, relatively large forces arerequired to bring about the formation of the staples. Again, only asmall force is needed to advance the knife. In addition to the above,and because it is necessary to ensure that the three-stage operation ofthe staple-carrying cartridge follows the proper sequence, the springforces associated with springs 40, 44 and 48 are not constant.

As a consequence of the above, the three stages of operation of theinstrument, when associated with the cartridge, result in variations ininput requirements. It should be apparent, therefore, that if nocorrecting provisions were made, the instrument would have peculiarcharacteristics from the standpoint of feel. To avoid these peculiarcharacteristics, the inventive surgical instrument is provided with avariable cam associated with a movable handle 18, which cam is designedso that the three-stage operation of the cartridge is carried out with arelatively uniform input force exerted by the operating surgeon.

With continuing reference then to FIG. 1, it can be seen that an arm 50continuous with the moveable handle 18 extends into the main body 14. Awheel, or disc, 52 is rotatably mounted on the end of the arm 50 anddefines a cam follower. The cam follower 52 is adapted to roll along thecamming surface 54 of a cam plate 56 pivotably mounted about a pin 58.While not shown, the upper region of the cam plate 56 is adapted to gripan extension associated with the cap 34 integral with the rod 32. Thesefeatures are not shown, in order to avoid obscuring pertinent details ofthe instrument but are fully illustrated and disclosed in copendingapplication Ser. No. 32,247, assigned to the present assignee. Sufficeit to say that the cam plate 56 is biased in what may be termed aclockwise direction about its pin 58 by means of the interaction of therespective springs 40 and 48.

In operation, as the moveable handle 18 is urged in the direction ofarrow 60, the arm 50 integral with the handle is caused to pivot aboutpin 20. As a result, the cam follower 52 is made to roll along thesurface 54 of the cam plate 56 while the cam plate pivots about pin 58.This movement takes place against the continuous resistance developed bythe respective springs 40 and 48. As can be seen in FIG. 1, the camfollower 52 engages the lower portion of the cam plate 56 when themoveable handle 18 is in the position 1. Then, the cam follower advancesalong the surface 54 until the moveable handle 18 is in its finalposition, position 4, at which time the cam follower 52 engages theupper portion of the cam plate 56.

As seen in FIG. 1, the surface 54 of the cam plate 56 has three maintransitions. These transitions enable the instrument It) to operate insuch a manner that a relatively uniform input force may be exerted onthe moveable handle 18 and so that this relatively uniform force may betransformed to forces of varying degrees of intensity to carry out thethree-stage operation of the cartridge 12 without the surgeon beingaware of such three-stage operation. Therefore, the distances betweenthe transitions are set in such a manner as to correspond to the desiredlength of thrust of the saddles 26, 28 and 30. Similarly, the shape andslope of the transitions are designed so that the mechanical advantageassociated with the handle-cam-drive rod assembly varies the forcesdelivered to the cartridge 12 under conditions of the uniform forcedelivery to the handle Now, with continuing reference to FIGS. 1 through4, the operation of the inventive instrument 10 will be described. Withthe moveable handle in the position l, the ring-like flange 38 lies inits rearwardmost position in the barrel 22, and the instrument isrelaxed. When, however, a force is exerted on the moveable handle 18,causing the handle 18 to pivot into position 2, the cap 34, integralwith the rod 32 and connected to the upper region of the cam plate 56,moves toward the nose 24 of the instrument 10. In view of the relativelylarge force exerted between the cap 34 and the ring-like flange 38, bythe 60 pound spring 48, the ring-like flange 38 moves with the cap 34into position 2. Hence, the spring 40 is compressed. At the same time,due to the action of the spring 44 which urges the saddle 30 away fromthe nose of the instrument 10, the saddle 30 moves the saddles 26 and 28away fromthe nose 24. In this manner, the cartridge main body portion,the pushers and the knife move, in unison, away from the nose 24.

As is fully explained in copending U.S. Patent Application Ser. No.32,247, noted above, the rail assemblies and anvils of the cartridge 12are fixedly secured to the nose 24 of the instrument 10 by means of apin 62 integral with the rail assemblies and anvils, which pin fits intogroove 64 in the nose 24 and is secured therein by a thumboperated lock66. With the rails and anvil assemblies held fixed with respect to theinstrument 10, and with the cartridge main body portion, the pushers andthe knife moving away from the nose 24, the main body portion of thecartridge 12 closes upon the fixed anvil assemblies as will be describedbelow. Position 2 of FIG. 1 shows the instrument when the main bodyportion just touches the anvil assemblies.

When the main body portion of the cartridge 12 comes into contact withthe fixed anvil assemblies, no further movement of the saddle 30 maytake place. Then, further rotation of the moveable handle 18 in thedirection of arrow 60 results in the saddles 26 and 28 moving, inunison, away from the then fixed saddle 30. In it s extreme positionduring this stage of operation, the handle moves into position 3 shownin FIG. 1, and the respective saddles take the positions shown in FIG.3.

The elements move into position 3 as follows. As noted previously, whenthe main body portion of the cartridge 12 contacts the fixed anvilassemblies, no further relative motion between these elements is allowedto take place. Therefore, all relative motion between the nose 24 of theinstrument l0 and the saddle 30 is terminated. However, with furtherrotation of the moveable handle 18, a force is exerted on the cap 34 andis directed toward the nose 24 of the instrument 10. This force movesagainst the spring 40 and results in continued movement of the saddles26 and 28. There is no relative movement between these saddles becausethe large spring 48, requiring 60 pounds of compression, remains fullyextended, with the pound spring 40 then being compressed.

When the instrument is in position 3, the knife associated with thesaddle 26 and the pushers associated with the saddle 28 have movedtoward the fixed anvil assemblies of the cartridge 12, with the pushersthen having completed the bending of the respective staples. At thistime, the pushers have reached their forwardmost stroke, having fullycrushed the respective staples and now in effect abutting the fixedanvil assemblies. Accordingly, both saddles 28 and 30 are in their fullyextended positions. Further rotation of the moveable handle 18 in thedirection of arrow 60 accordingly acts against the 60 pound spring 48and causes the saddle 26 to move away from the saddle 28. In itsultimate position, position 4, the knife has moved to its full forwardposition and has divided the already ligated organic tubular structure.The ultimate positions of the respective saddles are shown in FIG. 4.

From the above, it should now be appreciated that the forces required tooperate the elements of the staple carrying cartridge 12 in their propersequence, control the movement of the respective saddles in response toforces exerted on the moveable handle 18. And, since the surface 54 ofthe cam plate 56 is developed as described above, the differentialforces associated with the three springs and the three operations of thecartridge are substantially masked from the standpoint of the surgeon.Therefore, with the inventive instrument, a surgeon is able toautomatically, easily and comfortably carry out three distinct surgicaloperations in a minimum amount of time.

With reference now to FIGS. through 12, the construction and operationof the novel staple-carrying cartridge will be described. The cartridge12 comprises a main body portion 100 which is slidably mounted on a pairof rail assemblies 102 adapted to be fixedly secured to the instrument10. A curved anvil assembly 104 is defined in the forwardmost region ofeach rail assembly 102. A pair of pusher elements 106, rigidly securedtogether by means of a bridge 108, slide within the main body portion100. A knife 110, centrally located in the main body portion 100 slidesbetween the respective pushers 106 and is adapted to divide the organictubular structure after the pushers 106 have completed their strokes andhave effected the suturing of such structure. As can be seen best inFIGS. 6 through 8, the respective saddles 26, 28 and 30 positivelycontrol the movements of the knife 110, the pushers 106 and the mainbody portion 100 with respect to the rail assemblies 102 rigidly securedto the surgical instrument 10 by means of the pin 62 and thethumb-operated lock 66. Thus far, except for the automatic operation ofthe knife 110, the cartridge 12 functions in a manner identical with theoperation of the cartridge disclosed in copending application Ser. No.32,247, noted above.

As seen best in FIG. 11, a plurality of staples 112 are guided in one oftwo guide tracks on each side of the cartridge 12. For simplicity ofdescription, only one side of the cartridge will be mentioned, but itshould be understood that the cartridge is symmetrical about itscenterline.

A number of staples 112 lie along the major portion of the length of thecartridge 12 in what may be termed an index guide rail 114. It is in theindex guide rail 114 that the staples are, in unison, advanced towardthe anvil assemblies 104 in readiness for ejection. Near the forward endof the cartridge 12, the staples 112 are transferred to an ejectionguide rail 116. For purposes of transferring the staples from the indexguide rail 114 to the ejection guide rail 116, the main body portion 100is provided with a first ramp 1 18 which acts on the individual staplesat their respective cross-pieces and a second ramp 120 which acts on theindividual staples at the respective forward ends thereof. As can bestbe seen in FIG. 11, each pusher 106 is guided by and rides in theejection guide rail 116.

The cartridge 12 is provided with a novel staple feeding arrangement. Asseen best in FIG. 11, the novel staple feeding arrangement takes theform of a pair of interacting leaf spring assemblies. A first leafspring assembly is designated 122, is fixedly secured to the main bodyportion 100, and has its leaves extending into the plane of an indexguide rail 114. The second leaf spring assembly is designated 124, isfixedly secured to the rail assembly 102, and has its leaves alsoextending into the plane of an index guide rail 114. The forwardmostleaf 126 of the leaf spring assembly 122 is spring biased into the planeof the ejection guide rail 116, for reasons which will become clear fromthe following. Similarly, the forwardmost leaf 128 of the leaf springassembly 124 is formed into an L and extends into the plane of theejection guide rail 116. And, as can be seen best in FIG. 12, the leavesof the leaf spring assembly 124 are adapted to contact the staples 112at positions lower than the leaves of the leaf spring assembly 122.

The operation of the inventive staple-drive mechanism is as follows.When the cartridge 12 is shipped, the forwardmost two staples arepositioned as shown in FIG. 11. As noted previously, during shipment,the main body portion 110 is retracted and spaced from the anvilassembly 104. Upon initial activation of the associated surgicalinstrument 10, the main body portion 100 moves in the direction of arrow130. With such movement of the main body portion 100, the respectiveleaves of the leaf spring assembly 122 come into contact with theindividual staples 112 and carry such staples forward in unison with themain body portion 100. During this movement, the staples 112 remain inthe plane of the index guide rail 1 14.

It will be noted that a staple 112 is shipped in each ejection guiderail 116, in the plane of the pusher 106 and is thus in readiness forejection and forming around the anvil assembly 104. After the main bodyportion has come into contact with the anvil assembly 104, as mentionedabove, the pushers 106 begin their forward movement relative to the mainbody portion 100 and contact the respective forwardmost staples 112,eject the same from the main body portion 100 and form same around theorganic tubular structure housed within the jaws of the cartridge 12.Then, once the organic tubular structure is sutured, the knife 110 ismade to advance and to divide such structure intermediate the pair ofsuturing staples 112. During this forward movement of the pushers 106relative to the main body portion 100, all staples but the forwardmoststaples remain fixed in the main body portion.

Once a pair of staples have been ejected and formed, and the organictubular structure has been divided, the knife, the pushers and the mainbody portions are ready to be retracted from the region of the anvilassemblies. First, the knife retracts, then the pushers retract andfinally the main body portion retracts.

Before continuing, it should be noted that the forwardmost staple in themain body portion 100, save for the staple which was ejected, wasadvanced by the leaf 127, immediately behind the leaf 126 of the leafspring assembly 122 to a position beyond the leaf 128 of the leaf springassembly 124. The reference numeral 112 shows the position of theforwardmost staple in the main body portion 100, save for the staplehaving been ejected, after the completed movement of the main bodyportion 100 in the direction of arrow 130. The arrow 132 is provided toindicate the movement of the secondmost forward staple in the main bodyportion 100 during the forward stroke of the main body portion.

After the forward stroke of the pusher 106, the forwardmost stapleresiding in the main body portion 100 is the staple 112. After the knifeand the pushers have retracted, the main body portion 100 begins toretract. At this occurrence, the first ramp 1 18 comes into contact withthe cross-piece of the staple 112 while the second ramp comes intocontact with the forward arms of such staple. While the main bodyportion 100 is retracting, the staple 112 is held against the leaf 128of the leaf spring assembly 124. Similarly, the remaining staples in thecartridge are held against respective leaves of the leaf spring assembly124. With continued rearward movement of the main body portion 100, andwith the forwardmost staple 112 held against the front face of the leaf128, and being acted upon by the respective ramps 118 and 120, thestaple 112 is caused to transfer, in the direction of arrow 134, fromthe index guide rail 114 to the ejection guide rail 116. Once the mainbody portion 100 has returned to its rearwardmost position, theindividual elements of the assembly take the positions shown in FIG. 11.Then the cartridge is ready for the next stapling operation.

As noted previously, the forwardmost leaves 126 and 128 of therespective leaf spring assemblies 122 and 124 extend into the plane ofthe ejection guide rail 116 and thus extend into the plane of the pusher106. For this reason, and as best seen in FIG. 10, the pushers 106 arenotched at 136, in this way avoiding interference with the leaves of therespective leaf spring assemblies. And, as best seen in FIGS. 7, 10 and11, the forward face of each pusher 106 is provided with sets of flats138 serving to reduce the vertical diameter of the pushers with respectto the dimensions of the staples, thereby avoiding undesirableinterference between the pushers and the tip of ramp 120.

With continuing reference to FIGS. 5 through 10, some additionalfeatures of the inventive cartridge will be described. As seen best inFIGS. 5, 8, 9 and 10, an ejector plate 140 is positioned intermediatethe anvil assemblies 104. The ejector plate 140 functions to eject theorganic tubular structure from the jaws of the cartridge 12 after thecompletion of the suturing and dividing operations. During the forwardmotion of the main body portion 100, the ejector plate is carried withsaid main body portion and is moved out of the area of the anvilassemblies 104. Then, the pushers 106 and the knife 110 perform theirrespective functions and being to retract. When the main body portion100 retracts, the ejector plate 140 is carried with said main bodyportion into the area of the anvil assemblies 104, as a result of theinteraction between the rear portion of the knife and the rear portionof the ejector plate. In this manner, the surface of the ejector plate140 facing the ligated and sutured tubular organic structure urges suchstructure out of the area of the anvil assemblies 104 and hencefacilitates the expulsion of the divided tubular structure from the jawsof the cartridge. While not shown, the ejector plate 140 is limited inits movement with respect to the fixed rail assemblies 102. On thebottom of each rail assembly, there is provided a downwardly extendingflange. And, surrounding each such flange is a slot provided in thebottom portion of the ejector plate. The width of the ejector plate slotis made slightly greater than the width of the downwardly projectingflange, thereby allowing slight relative movement between the railassemblies, and hence the anvil assemblies, and the ejector plate.

As noted previously, certain elements of the inventive cartridge 12 areheld fixed with respect to the main body portion 100 until acted upon bythe associated surgical instrument. This is desirable for two distinctand important reasons. First, it is advantageous to maintain the railassemblies, the main body portion, the pushers, and the knife in therespective positions facilitating insertion of the cartridge on theassociated surgical instrument. And, second, it is necessary to preventthe pushers from accidentally ejecting a pair of staples from thecartridge and to prevent the knife from accidentally travelling forwardin the cartridge before such cartridge is mounted on the associatedinstrument. Therefore, the inventive cartridge 12 is provided with meansto releasably lock the knife, pusher and rail assemblies fixed withrespect to said main body portion.

The knife 110 and pushers 106 are releasably locked with respect to themain body portion 100 as follows. On the upper surface of the knife 110,there is provided a notch 142. And, provided on the upper surface of themain body portion 100 is a detent 144. The detent 144 is resilientlybiased into the plane of the notch 142 and is aligned therewith.Therefore, when the knife 110 is in its rearwardmost position, with thecartridge ready to be inserted on the associated surgical instrument,the detent 144 fits within the notch 142 and locks the knife 110 inposition with respect to the main body portion 100. On the upper surfaceof the knife 110 is also provided an elongated depression 147. Adaptedto slide within the depression 147 is the bridge 108 rigidly securingone pusher element 106 to the other. In this manner, when the knife 110is locked in position with respect to the main body portion 100, so tooare the pushers 106.

In a manner similar to that described above, the main body portion 100is releasably locked in place with respect to the rail assemblies 102. Aplastic spacer bar 146 is provided at the rear of the rail assemblies102. And, at the forward portion of the spacer bar 146, there isprovided a detent 148 resiliently biased into the plane of the bottom ofthe main body portion 100. A notch 150 is located in the main bodyportion 100 and is adapted to align with the detent 148 when therespective positions of the rail assemblies 102 and the main bodyportion 100 are suitable for insertion on an associated surgicalinstrument.

Above, there has been described a novel cartridge and instrument forligating, suturing and dividing an organic tubular structure. It shouldbe appreciated, however, that the above description is given forpurposes of illustration only and that a number of modifications andalterations may be practiced by those skilled in the art withoutdeparting from the spirit or scope of the invention. It is the intent,therefore, that the invention not be limited to the above but be limitedonly as defined in the appended claims.

What is claimed is:

1. A cartridge adapted for removeable insertion on a surgical instrumentand having the capability of confining an organic tubular structure in aclosed area within its jaws, encircling the structure with a pair ofspaced apart surgical staples, suturing the structure with said surgicalstaples, and dividing the structure intermediate said surgical staples,the cartridge comprising: an elongated main body portion moveablerelative to a rail assembly; a first pair of spaced apart guide tracksin said main body portion, each such guide track for guiding one stapleof a plurality of serially spaced staple pairs along the length of saidmain body portion; a second pair of spaced apart guide tracks in saidmain body portion, each such guide track for singly guiding one stapleof said plurality of staple pairs out of the region of said main bodyportion; the respective planes of each of said first pair of guidetracks being parallel to and spaced from the respective planes of eachof said second pair of guide tracks for singly transferring said staplepairs from said first pair of guide tracks to said second pair of guidetracks; a third pair of guide tracks continuous with and in the plane ofsaid second pair of guide tracks and extending external to said mainbody portion; a closeable opening in each of said third pair of guidetracks for the insertion of the organic tubular structure; a pair ofcurved anvil means continuous with and in the respective planes of saidthird pair of guide tracks; a pair of pusher elements in the respectiveplanes of said second pair of guide tracks, each pusher element forsingly advancing one staple of said plurality of staple pairs along oneof said second guide tracks and one of said third guide tracks and forforming such staple on respective anvil means; knife means centrallymounted for movement in said main body portion intermediate theindividual guide tracks and serving to divide said organic tubularstructure; and means for transferring each of the staples of theforwardmost staple pair in said main body portion from the respectiveguide track of the first pair of guide tracks to the respective guidetrack of the second pair of guide tracks.

2. The cartridge recited in claim 1, wherein the means for transferringstaples takes the form of a first set of staple-holding elements formaintaining the plurality of staples fixed with respect to said railassembly during the movement of said main body portion away from saidcurved anvil means.

3. The cartridge recited in claim 2, and further comprising: a secondset of staple-holding elements for maintaining the plurality of staplesfixed with respect to said main body portion during the movement of saidmain body portion toward said curved anvil means.

4. The cartridge recited in claim 3, wherein said first set ofstaple-holding elements takes the form of a plurality of flexiblemembers extending into the respective planes of said plurality ofstaples and adapted to contact said plurality of staples; and whereinthe forwardmost members of said plurality of flexible members serve toshift the forwardmost staples from said first pair of guide tracks tosaid second pair of guide tracks.

5. The cartridge recited in claim 4, wherein said first and said secondstaple-holding elements are each in the form of leaf spring assemblies,the individual leaves of which are adapted to be moved out of therespective planes of said plurality of staples when the leaves of theother of said assemblies is maintaining the positions of said pluralityof staples.

6. The cartridge recited in claim 4, wherein said first set ofstaple-holding elements is mounted on said respective rail assemblies;and wherein the second set of staple-holding elements is mounted on saidmain body portion.

7. The cartridge recited in claim 6, wherein the forwardmost element ofeach first staple-holding elements extends from the plane of therespective first guide track to the plane of the respective second guidetrack and is adapted to contact the respective forwardmost staple duringits transition from said first guide track to said second guide track.

8. The cartridge recited in claim 4, wherein each of said pair of pusherelements is slotted so as to allow for the free passage of said pusherelements past said first and second staple-holding elements withoutcontact therebetween.

9. The cartridge recited in claim 1, wherein said knife means is adaptedto move in unison with said pair of pusher elements, lagging said pusherelements until a time when said pusher elements are in their fullyforward positions in said main body portion 10. The cartridge recited inclaim 9, and further comprising means for ejecting the organic tubularstructure after the ligating, suturing and dividing operations.

11. The cartridge recited in claim 10, wherein said ejector means ispositioned intermediate said pair of anvil means and frictionallyengages said main body portion.

12. The cartridge recited in claim 1, and further comprising means forreleasably locking said knife means in said main body portion.

13. The cartridge recited in claim 12, wherein said knife locking meanstakes the form of a notch defined in said knife and a flexible detentdefined in said main body portion adapted to align with and releasablylock in said notch.

14. The cartridge recited in claim 12, and further comprising means forreleasably locking said pusher elements in said main body portion.

15. The cartridge recited in claim 14, wherein said respec tive pusherelements are joined together by a bridge; wherein said knife means isprovided with a slot adapted to encompass and associate with saidbridge; and wherein said pusher elements are restrained against movementin said main body portion by their association with said knife means.

16. The cartridge recited in claim 15, wherein said knife locking meanstakes the form of a notch defined in said knife and a flexible detentdefined in said main body portion adapted to align with and realeablylock in said notch.

17. The cartridge recited in claim 1, and further comprising means forreleasably locking said rail assembly in said main body portion.

18. The cartridge recited in claim 17, wherein said locking means takesthe form of a notch defined in said main body portion adapted to alignwith said detent and a flexible detent defined in said rail assemblyadapted to align with and releasably lock in said notch.

19. The cartridge recited in claim 1, wherein the respectiverearwardmost portions of said main body portion, said pusher elements,said knife means and said rail assemblies, are staggered with respect tothe forward end of said cartridge and are each provided with means forassociating with a surgical instrument.

1. A cartridge adapted for removeable insertion on a sUrgical instrumentand having the capability of confining an organic tubular structure in aclosed area within its jaws, encircling the structure with a pair ofspaced apart surgical staples, suturing the structure with said surgicalstaples, and dividing the structure intermediate said surgical staples,the cartridge comprising: an elongated main body portion moveablerelative to a rail assembly; a first pair of spaced apart guide tracksin said main body portion, each such guide track for guiding one stapleof a plurality of serially spaced staple pairs along the length of saidmain body portion; a second pair of spaced apart guide tracks in saidmain body portion, each such guide track for singly guiding one stapleof said plurality of staple pairs out of the region of said main bodyportion; the respective planes of each of said first pair of guidetracks being parallel to and spaced from the respective planes of eachof said second pair of guide tracks for singly transferring said staplepairs from said first pair of guide tracks to said second pair of guidetracks; a third pair of guide tracks continuous with and in the plane ofsaid second pair of guide tracks and extending external to said mainbody portion; a closeable opening in each of said third pair of guidetracks for the insertion of the organic tubular structure; a pair ofcurved anvil means continuous with and in the respective planes of saidthird pair of guide tracks; a pair of pusher elements in the respectiveplanes of said second pair of guide tracks, each pusher element forsingly advancing one staple of said plurality of staple pairs along oneof said second guide tracks and one of said third guide tracks and forforming such staple on respective anvil means; knife means centrallymounted for movement in said main body portion intermediate theindividual guide tracks and serving to divide said organic tubularstructure; and means for transferring each of the staples of theforwardmost staple pair in said main body portion from the respectiveguide track of the first pair of guide tracks to the respective guidetrack of the second pair of guide tracks.
 2. The cartridge recited inclaim 1, wherein the means for transferring staples takes the form of afirst set of staple-holding elements for maintaining the plurality ofstaples fixed with respect to said rail assembly during the movement ofsaid main body portion away from said curved anvil means.
 3. Thecartridge recited in claim 2, and further comprising: a second set ofstaple-holding elements for maintaining the plurality of staples fixedwith respect to said main body portion during the movement of said mainbody portion toward said curved anvil means.
 4. The cartridge recited inclaim 3, wherein said first set of staple-holding elements takes theform of a plurality of flexible members extending into the respectiveplanes of said plurality of staples and adapted to contact saidplurality of staples; and wherein the forwardmost members of saidplurality of flexible members serve to shift the forwardmost staplesfrom said first pair of guide tracks to said second pair of guidetracks.
 5. The cartridge recited in claim 4, wherein said first and saidsecond staple-holding elements are each in the form of leaf springassemblies, the individual leaves of which are adapted to be moved outof the respective planes of said plurality of staples when the leaves ofthe other of said assemblies is maintaining the positions of saidplurality of staples.
 6. The cartridge recited in claim 4, wherein saidfirst set of staple-holding elements is mounted on said respective railassemblies; and wherein the second set of staple-holding elements ismounted on said main body portion.
 7. The cartridge recited in claim 6,wherein the forwardmost element of each first staple-holding elementsextends from the plane of the respective first guide track to the planeof the respective second guide track and is adapted to contact therespective forwardmost stapLe during its transition from said firstguide track to said second guide track.
 8. The cartridge recited inclaim 4, wherein each of said pair of pusher elements is slotted so asto allow for the free passage of said pusher elements past said firstand second staple-holding elements without contact therebetween.
 9. Thecartridge recited in claim 1, wherein said knife means is adapted tomove in unison with said pair of pusher elements, lagging said pusherelements until a time when said pusher elements are in their fullyforward positions in said main body portion.
 10. The cartridge recitedin claim 9, and further comprising means for ejecting the organictubular structure after the ligating, suturing and dividing operations.11. The cartridge recited in claim 10, wherein said ejector means ispositioned intermediate said pair of anvil means and frictionallyengages said main body portion.
 12. The cartridge recited in claim 1,and further comprising means for releasably locking said knife means insaid main body portion.
 13. The cartridge recited in claim 12, whereinsaid knife locking means takes the form of a notch defined in said knifeand a flexible detent defined in said main body portion adapted to alignwith and releasably lock in said notch.
 14. The cartridge recited inclaim 12, and further comprising means for releasably locking saidpusher elements in said main body portion.
 15. The cartridge recited inclaim 14, wherein said respective pusher elements are joined together bya bridge; wherein said knife means is provided with a slot adapted toencompass and associate with said bridge; and wherein said pusherelements are restrained against movement in said main body portion bytheir association with said knife means.
 16. The cartridge recited inclaim 15, wherein said knife locking means takes the form of a notchdefined in said knife and a flexible detent defined in said main bodyportion adapted to align with and realeably lock in said notch.
 17. Thecartridge recited in claim 1, and further comprising means forreleasably locking said rail assembly in said main body portion.
 18. Thecartridge recited in claim 17, wherein said locking means takes the formof a notch defined in said main body portion adapted to align with saiddetent and a flexible detent defined in said rail assembly adapted toalign with and releasably lock in said notch.
 19. The cartridge recitedin claim 1, wherein the respective rearwardmost portions of said mainbody portion, said pusher elements, said knife means and said railassemblies, are staggered with respect to the forward end of saidcartridge and are each provided with means for associating with asurgical instrument.